[Congressional Record (Bound Edition), Volume 155 (2009), Part 21]
[Senate]
[Pages 29050-29063]
[From the U.S. Government Publishing Office, www.gpo.gov]




             SERVICE MEMBERS HOME OWNERSHIP TAX ACT OF 2009

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will resume consideration of H.R. 3590, which the clerk will 
report.
  The assistant legislative clerk read as follows:

       A bill (H.R. 3590) to amend the Internal Revenue Code of 
     1986 to modify the first-time home buyers credit in the case 
     of members of the Armed Forces and certain other Federal 
     employees, and for other purposes.

  Pending:

       Reid amendment No. 2786, in the nature of a substitute.
       Mikulski amendment No. 2791 (to amendment No. 2786), to 
     clarify provisions relating to first-dollar coverage for 
     preventive services for women.
       McCain motion to commit the bill to the Committee on 
     Finance, with instructions.

  The ACTING PRESIDENT pro tempore. Under the previous order, the time 
until 11:30 will be equally divided with alternating blocks of time, 
with Republicans controlling the first 30 minutes and the majority 
controlling the second 30 minutes.
  The Senator from Wyoming is recognized.
  Mr. ENZI. Mr. President, I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. KYL. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. KYL. Mr. President, to continue our debate on the McCain 
amendment to ensure Medicare benefits for our seniors are not cut, as 
would happen under this legislation, I wanted to talk a little bit 
about the commitments we have made to our seniors and what exactly 
would happen under the legislation that is before us.
  As we all know, seniors have paid into the Medicare Program, and that 
is with the expectation that they will get the benefits that have been 
promised to them. The question is, Why would we, at this point, reduce 
the benefits that have been promised to them, especially if the purpose 
is not to enhance the financial viability of Medicare, which everyone 
knows is going broke but, rather, to use that money to establish a new 
entitlement program?
  Let me break down the list of cuts seniors would face under this 
legislation: $137.5 billion would be cut from hospitals that treat 
seniors, $120 billion from the Medicare Advantage plan. By the way, 
that Medicare Advantage plan serves almost 40 percent of the Arizona 
seniors on Medicare. It cuts $14.6 billion from nursing homes, $42.1 
billion from home health care, and $7.7 billion from hospice care. 
These are deep cuts, and you cannot avoid jeopardizing the health care 
seniors now have under Medicare by making these deep cuts. That is why 
the Chief Actuary at the Centers for Medicare and Medicaid Services--we 
use the initials CMS--believes these cuts would cause some providers to 
end their participation in Medicare, which, of course, would further 
threaten seniors' access to care. There would not be as many providers 
to whom they could go for their services.
  Our friends on the other side of the aisle say part of this is an 
intention to eliminate waste, fraud, and abuse. Of course, we have 
known for many years that there is waste, fraud, and abuse in Medicare, 
but actually doing something about the problem and recognizing it are 
two different things. If it were easy to wring hundreds of billions of 
dollars of savings from Medicare by just pointing to waste, fraud, and 
abuse, we would have done it a long time ago. Certainly the President 
would, during his first year in office, want to do that, given the fact 
we are spending a lot of money and he is trying to find sources of 
revenue for the various spending programs he has proposed. If it were 
that easy to do, it would have been done before now.
  Moreover, Medicare faces a $38 trillion, 75-year unfunded liability. 
That is almost incomprehensible. Most of us believe that whatever 
savings we could achieve in Medicare, to the extent you could eliminate 
waste, fraud, and abuse, for example, you should do that to help make 
Medicare solvent.
  Next I want to talk about what seniors are telling us. They believe, 
according to public opinion surveys--and I have talked to enough of 
them to know this is true--that these Medicare cuts are going to 
jeopardize their health care. They are troubled in particular by this 
$120 billion proposed cut to Medicare Advantage. It has been called the 
crown jewel of Medicare. It is the private insurance addition to 
Medicare in which many are able to participate in programs they would 
never have been able to afford otherwise. It gives them this choice to 
supplement Medicare to provide all kinds of benefits such as dental, 
vision, hearing, physical fitness programs, and other things, as I 
said, that they could not get otherwise. One in four of the 
beneficiaries in Arizona, as I said, signs up for this program--more 
than 329,000 seniors. They like the low deductibles and copayments in 
Medicare Advantage.
  But the Congressional Budget Office has bad news for the seniors who 
like this program and who like the extra benefits they have under 
Medicare Advantage because, as the Congressional Budget Office notes, 
it would cut benefits on average by 64 percent over the next 10 years, 
from an actuarial value of $135 to $49 a month. Think about that. The 
actuarial value of the benefits the average Medicare Advantage 
participant has is worth $135 a month today. It would be cut in this 
bill to $49 a month. That is a 64-percent cut, according to the 
Congressional Budget Office. When we say we are not cutting benefits 
seniors currently receive, that is not true. This legislation would do 
that.
  I have been sharing letters from constituents who have expressed 
concerns to me. Let me share three more letters today.
  One recently arrived from Joseph and Mary-Lou Dopak of Sun City West, 
in Arizona, of course. They wrote as follows:

       The plan to reduce our coverage and take $120 billion from 
     Medicare Advantage is a

[[Page 29051]]

     slap in the face to all seniors. The Medicare Advantage plan 
     works because Medicare funds are given to a private insurance 
     company to administer the plan.
       We do not want our Medicare Advantage plan robbed to fund a 
     government-operated comprehensive health insurance plan. 
     Commonsense tells us that will not work.
       The President should be fixing what ails the current health 
     care system, instead of putting everyone into a government-
     operated health care plan.
       For our President to pick on Medicare Advantage is totally 
     unfair to those of us upon whose shoulders this country has 
     been built.

  A constituent from Tucson, AZ, wrote a rather short and direct 
letter, and so it is easy to quote here.

       I am a senior citizen age 83. If I lose my Medicare 
     Advantage coverage, I'll also lose my primary care physician 
     of 18 years because he does not accept Medicare Direct. 
     Senator Kyl, do not let them take away my Medicare Advantage.

  I get these letters every day. I have not yet had a constituent come 
up to me and say: Please, would you take away the Medicare Advantage 
Program, it is not right. Everybody has said, of course: Please 
preserve this important program.
  Finally, a constituent from Phoenix, AZ, who suffers from multiple 
sclerosis, describes what it means to her.

       I am a 57-year-old woman with multiple sclerosis, currently 
     on Social Security Disability. I make under $14,000 a year 
     and have been on the Secure Horizons Medicare Advantage plan 
     for a long time now. . . .
       I realize it is hard for Congress to understand, but we 
     need to keep our Medicare Advantage plans in order to have 
     [quality] health care at a price we can afford.
       We need you to help protect Medicare Advantage plans for 
     the seniors in your State. We are the ones you need to fight 
     for and we should not have to choose between going to a 
     doctor and getting our medication and having food on the 
     table and a place to live. Please do your part to protect our 
     Medicare Advantage plans and keep prices within our reach.

  As I said, these are the kinds of letters we get all the time. It is 
hard for these folks to understand, first of all, why, having paid into 
the plan and having taken advantage of what is a good supplement to the 
basic Medicare, that would be taken away from them. I think it is even 
harder for them to fathom that the reason it is being done is to pay 
for a new program rather than to keep Medicare itself solvent.
  I tell folks like this that I will continue to fight for her and I 
will continue to try to protect this program because we believe it is 
essential. It is why I support the McCain amendment to commit the bill 
back to committee. It only has to be there a day. We are not talking 
about a further delay here. But it addresses both of the key issues of 
cuts and savings. If the McCain amendment passes, it would send the 
bill back to the Finance Committee with instructions to remove the 
Medicare cuts from the bill. That is all it does. But, second, those 
savings would be applied to Medicare rather than to fund a new 
government program. Those savings could therefore address the waste, 
fraud, and abuse problem that has been identified by everyone. It can 
be used to strengthen the Medicare trust fund rather than to fund a new 
health care entitlement program.
  We believe the first thing we should do to see whether we can 
actually fix this bill--I have been quoted as saying that I don't think 
we can fix this bill. By that, I mean, with all due respect to my 
colleagues on the other side of the aisle, I don't think they want to 
make the changes I think would be necessary for the American people to 
begin to support this kind of legislation. Seniors are overwhelmingly 
opposed to the Medicare cuts. That is a fact. If my colleagues on the 
other side of the aisle are not willing to support the McCain amendment 
or something like it, I don't know how we could then say we can fix 
this bill. So I hope my colleagues will use this process we have to 
actually make amendments to the bill and not simply have a political 
discussion.
  Republicans have pointed out that there are better ways to reform the 
health care problems we have today than to do it on the backs of 
seniors. We put forth a bounty of ideas. Let me just recoup some of 
them.
  We think we could start and we could save a great deal of money by 
medical malpractice reform. That would bring down costs. We could allow 
Americans to buy lower cost insurance policies across State lines. That 
alone would unleash a wave of competition for patients' business. We 
could allow small businesses to band together to get the same 
purchasing power big businesses have. These ideas have essentially been 
ignored by the majority. Instead, we have this big government takeover 
of health care at a huge cost and significant reduction in quality and 
benefits to the American people. We don't think this is the way to go.
  Certainly, on behalf of my senior citizen constituents and others who 
are on Medicare Programs, I am going to continue to fight for them, as 
my colleague John McCain is, and therefore urge my colleagues to 
support his amendment to eliminate the Medicare cuts under this bill.
  The ACTING PRESIDENT pro tempore. The Senator from Kansas is 
recognized.
  Mr. BROWNBACK. Mr. President, I rise to speak in favor of the McCain 
motion, and I do it from the perspective of a representative of the 
State of Kansas.
  We have a number of senior citizens and hospitals that are Medicare-
dependent. We have a number of providers for whom a majority of their 
practice is Medicare reimbursement. They are scared to death of these 
cuts, and the cuts are well documented--$500 billion in Medicare cuts, 
and for the 43 million senior citizens on a program that is already 
projected to go insolvent by 2017, specific cuts of $135 billion from 
hospitals, $120 billion from 11 million seniors in Medicare Advantage, 
nearly $15 billion from nursing homes, nearly $40 billion from home 
health agencies, and then--a cruel gesture, it seems to me--nearly $8 
billion from hospice, where people are getting their final care for 
cancer and diseases that are killing them--$8 billion cut from hospice.
  What that does in a State such as mine and in many rural hospitals, 
it cuts the legs out from under them. They are not going to have the 
money they need to operate. They are going to do everything they can to 
continue to operate--and they will, probably. What they will try to do 
is tax their local citizenry, raise property taxes, in all probability, 
to make up for the Medicare cuts because they are going to have a 
hospital there and they are going to do everything they can to keep a 
hospital there.
  But what a terrible gesture on our part here, to take money that has 
been going into Medicare--and people have been paying into Medicare--
and then steal it for a new program that is not going to get everybody 
covered on top of that and from a program that is already set to go 
insolvent by 2017. It is like writing a big fat check on an overdrawn 
bank account to start something new, to buy a new motorcycle. That 
doesn't make sense to people. Then it seems cruel and unusual to the 
senior citizens that you are taking $500 billion and really gutting a 
lot of their care programs on a program that doesn't work.
  I met earlier, within the last several days, with the Kansas 
Association of Anesthesiologists. They are looking at these things and 
saying: This is really going to hurt us and our ability to provide 
services and care. I talked with other individuals who look at this, 
and they say: Wait a minute, you are going to change everything to try 
to get a few more people covered and you are going to gut a Medicare 
program that is not paying the bills now, that a number of private 
insurance plans are helping to subsidize Medicare and Medicaid, and you 
are going to cut the reimbursements that are not making things work 
yet? It makes no sense to individuals that this would take place.
  I get called by a number of individuals across the State of Kansas 
saying they are very scared of this bill and what it is going to do to 
their health care. I do telephone townhall meetings, as a number of 
individuals across this body do, and the individuals there whom you get 
on a random phone calling basis are scared and mad about this bill and 
the prospects of what it does to their health care. I get it from 
individuals. I get it from mail.

[[Page 29052]]

  I was in a meeting in Kansas the week of Thanksgiving, and I polled 
the audience--it was an audience that was mostly over the age of 65--
how many were in favor of the overall bill? There were about 200-some 
people there, and 10 were in favor. How many opposed? Everybody else, 
with a few saying they don't have an opinion. But it was 90 percent, 95 
percent opposed to this bill, and it is because they look at it and 
they see what it is going to do to them, and they don't see it 
providing the care that is being promised--and adding, on top of that, 
to the deficit.
  One of two things is going to happen on these Medicare cuts, because 
we have seen, in the past, efforts to control the spending in Medicare 
passed by this body and then each year those cuts to try to restrain 
the spending on Medicare being restored.
  One of two things is going to happen. Either these cuts in Medicare 
are going to take place, and it is going to cripple the program and 
particularly hurt it in a number of rural areas across the country and 
in my State, or these cuts will never take place in Medicare and it is 
going to add to a ballooning deficit and debt that is taking place 
right now. Either choice is an irresponsible choice for this body to 
do. It is irresponsible for us to do for this country. Most people look 
at it and say: I want to get more people covered, and I want to bend 
down the cost curve. But let's do that on an incremental basis.
  Senator Kyl spoke about incremental changes that can take place, 
whether it is tort reform, allowing bigger pooling on health insurance, 
whether it is starting more community-based clinics, one that I look at 
as something that has worked in my State to get more people covered at 
an earlier phase in their health care needs. All of those are 
incremental, low cost, and, in some cases, ones that actually do bend 
down the cost curve and that can help, not a gargantuan $2.5 trillion 
program that takes $500 billion out of Medicare that is already headed 
toward insolvency in less than a decade. The bill doesn't make sense to 
individuals.
  Then to do it on top of a time period when the President, 10 days 
ago, comes back from China, meeting with our bankers, as most people 
look at it, and the bankers lecturing us on why are we spending more 
money which we don't have, going further and further into debt, which 
we should not do at this point in time, being lectured by the Chinese 
when we ought to be talking to them about what they are doing about 
human rights and currency. We are being lectured about fiscal 
irresponsibility, and it is because of bills such as this. If we just 
stop and slow down and listen to seniors and others across this 
country, there is a commonsense middle ground that we can go to, that 
doesn't cost anything along the nature of this, doesn't change health 
care for most people but addresses the narrow problem of getting the 
cost curve down, of getting more people covered. This bill with these 
cuts in Medicare cripples many of my providers in the State of Kansas 
and will make them raise property taxes to keep the hospitals open, to 
try to provide doctors in the community--a lot of the hospitals are 
going to close and a lot of providers will stop providing Medicare--or, 
in all probability, these cuts will never happen, and it will be added 
to the debt and deficit, completely irresponsible toward our kids.
  I urge my colleagues to vote for the McCain motion that makes sense, 
that is what the citizenry wants to do: send these cuts in Medicare 
back to communities and pull out of this bill.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Tennessee.
  Mr. CORKER. Mr. President, how much time remains on our side?
  The ACTING PRESIDENT pro tempore. There is 7 minutes 6 seconds.
  Mr. CORKER. I thank the Chair.
  Mr. President, I am glad to be on the floor of the Senate with the 
distinguished Senators from Kansas and Connecticut and Montana. We have 
obviously before us one of the most important issues we will deal with 
in this body.
  I have had over 40 townhall-like meetings since the beginning of 
August. I can say without hesitation that I have never used those 
meetings to try to focus on some of the hot-button issues that divide 
us. On not one occasion have I tried to do that. I have tried to focus 
on the fundamentals of this health care bill. Way back when, when I 
began meeting with the distinguished chairman of the Finance 
Committee--I greatly appreciated his desire to meet with me--and 
realized that Medicare may be a place where money will be taken to 
leverage a new entitlement, I began expressing my concerns about that.
  Later, I sent a letter to Majority Leader Reid, signed by 36 
Senators, talking about the fact that if Medicare moneys were used to 
leverage a new entitlement, we could not support that effort.
  The reason I say this is, this is the same exact thing I have been 
saying about this bill from day one, before it was ever constructed. I 
am very dismayed that we find ourselves here in December debating a 
bill that does exactly that.
  When I first came to this body, there was a lot of concern about the 
solvency of Medicare. Everyone here knows the trustees have stated that 
in 2017 Medicare will be absolutely insolvent. Two Senators from 
opposite sides of the aisle have tried to create legislation that would 
put in place a commission, eight Republicans and eight Democrats, to 
actually solve that issue. We realize we do not have the resources in 
Medicare to actually deal with the liabilities we have with seniors.
  The fact that we are taking $464 billion in savings out of Medicare 
to leverage a new entitlement, to me, is totally irresponsible. It is 
the same thing I have been saying from day one. I am dismayed that we 
would consider kicking the can down the road, making sure that people 
of the generation of the many people who are helping us on the floor 
today will be saddled with huge amounts of cost that they will not be 
able to deal with in a responsible manner. I am discouraged.
  The fact is, the other piece of this that is extremely troubling is 
that we all know we have the issue of SDR, the doc fix, which is a 
colloquial term to describe the fact that in any year after this bill 
passes, physicians across the country will be receiving a 23-percent 
cut for serving Medicare recipients. Medicare recipients understand 
what that means. It means they will have less physicians to deal with 
the needs they will have at that time. This bill, instead of dealing 
with that issue, deals with it for one year. What that means is there 
is about $250 billion worth of expenses that are not being dealt with 
with this Medicare savings.
  Let me go walk it one more time. We have a program that is insolvent. 
We have a program that cannot meet the needs of those people who have 
paid into it for years and many of us continue to pay into. This 
program is insolvent, and we are going to take moneys out of this 
program, $464 billion--something that most Americans cannot do, 
something that does not pass the commonsense test in Tennessee, and my 
guess is doesn't pass the commonsense test in most States--we are going 
to take $464 billion out of this program, this entitlement which is 
underfunded and insolvent, and we will leverage it to create a new 
entitlement for Americans. Yet we are not going to deal with the issue 
of the doc fix, which is a $250 billion issue. We are going to kick the 
can down the road. We are going to cause physicians around the country 
next year to, if this bill passes--if not, certainly they will be 
dealing with that this year--but we are going to cause physicians 
around the country another year to be concerned about these huge cuts, 
not deal with it in this bill, and possibly end up with a $250 billion 
obligation that could have been dealt with during this health care 
reform that now is not met, that is going to create additional fiscal 
burdens to this country and certainly great distress to seniors and 
physicians who care for them.
  I tried to stick with the basic fundamental building blocks of this 
bill. I don't think anybody in this body has ever heard me focus on 
some of the more emotional issues. The fact that

[[Page 29053]]

we would use Medicare moneys to create a new entitlement, the fact that 
we would have an unfunded mandate to States through Medicaid of $25 
billion, to me, is problematic; the fact that premiums are going to 
increase, whether it is the CBO number of 10 to 13 percent or the 
Oliver Wyman number in my State which says 60 percent, the fact that 
private premiums are going to go up and the fact that we are using 6 
years' worth of costs and 10 years' worth of revenues--I don't know how 
we have gotten caught up in this debate in such a manner that we are 
ignoring basic fundamentals that I don't think any of us on our own 
accord would consider supporting.
  The fact is, I am afraid this, again, has become nothing but a 
political victory for the President.
  What I hope we will do is step back and do some things in a 
bipartisan way that will stand the test of time. I ran on health care 
reform. I would like to see us do responsible health care reform. The 
basic fundamentals of this bill do not meet that test.
  I see my time has expired. I thank the Chair and the Senators on the 
other side of the aisle who have worked hard to put this bill together. 
I hope they will step back away from these flawed fundamentals, and I 
hope in some form or fashion we will put together a bill that will 
stand the test of time.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Connecticut is 
recognized.
  Mr. DODD. Mr. President, how much time do we have?
  The ACTING PRESIDENT pro tempore. The Senator has 30 minutes.
  Mr. DODD. Mr. President, let me first talk about the Medicare issue, 
because this has been the subject of sort of round-and-round debate, 
back and forth over the last couple of days. It is important to share, 
again, as emphatically as I know how what is being done with regard to 
Medicare. The whole idea is to strengthen Medicare, to put it on a 
sounder footing, to extend its solvency from 8 years by an additional 5 
years, which we do under this bill, making it a stronger, more reliable 
source of health care for older Americans.
  In fact, the finest and largest organization representing older 
Americans, which doesn't lightly endorse proposals without examining 
them thoroughly--hardly a partisan group given the fact of where they 
have been on these issues--has put out, once again, in the last 24 
hours, a statement laying out the facts of what is included in the bill 
drafted by the Finance Committee principally in this area of Medicare.
  Let me recite, if I may, the facts as they identify them. Fact No. 1, 
none of the health care reform proposals being considered by Congress 
would cut Medicare benefits or increase out-of-pocket costs for 
Medicare services. That is not from the Democratic National Committee. 
It is not from the HELP Committee or the Finance Committee. This is 
from AARP saying: None of the proposals in this bill cut Medicare 
benefits or cut Medicare services.
  Fact No. 2, the health care reform bill drafted by the Finance 
Committee will lower prescription drug costs for people in the Medicare 
Part D coverage gap, or the so-called doughnut hole with which many 
seniors are familiar.
  We are going to cut the cost of prescription drugs. Again, this is 
not from some partisan group announcing what is in the bill. This is 
from an objective, nonpartisan analysis of the bill that is before us.
  Fact No. 3, health care reform will protect seniors' access to their 
doctors and reduce the cost of preventive services so patients stay 
healthier. Again, that is critical.
  I presume others understand this; it is so axiomatic you wonder why 
you have to explain it. It is better to catch a problem before it 
becomes a major problem. Through mammograms, colonoscopies, obviously 
examinations and screenings, you can discover that an individual has a 
problem and, if caught early enough, can address it. As many of my 
colleagues know because it became rather public, I went through cancer 
surgery in August. It was discovered that I had an elevated PSA test, 
indicating I had prostate cancer. That screening let me know that I had 
a growing problem that I had to deal with. So I went through a variety 
of discussions on what best to do, what was the best way to handle all 
of this and decided that surgery made the most sense.
  The cost of that surgery is expensive. It is not cheap--$5,000, 
$6,000, $7,000, $8,000 to do it. If I had not discovered I had prostate 
cancer and it had grown, I could have become 1 of the 30,000 men a year 
in this country who die from it, or if I had waited longer for it to be 
full-blown cancer, I am told it could have easily cost $250,000. So by 
catching this early and getting the needed treatment, I was not only 
able to stay alive and stay healthier, with two young daughters aged 4 
and 8--and looking forward to the day I may dance at their weddings--
but also there were the savings because it did not grow into a problem 
that would require massive expenditures to deal with it.
  Our bill deals with that. We provide for the first time ever that 
seniors and other Americans have access to prevention and screening 
tests that would allow them to discover problems they have early on. 
That is according to AARP. That is what we drafted in this legislation. 
It is a major benefit.
  I listened to our colleague from North Carolina yesterday, Senator 
Hagan, talk about nurses in a hospital in her State of North Carolina 
who were not getting mammograms early, not because they did not want 
them but because, of course, the out-of-pocket expenses for them are so 
high they could not afford to do it and pay rent and put food on the 
table and take care of their families.
  That hospital in North Carolina decided they were no longer going to 
require their nurses to pay those high out-of-pocket expenses and they 
eliminated that. As a result, every nurse--or almost every nurse--in 
that hospital got those mammograms early on and, of course, could 
identify problems before they became larger issues for them to grapple 
with.
  That is what this bill of ours does. That is a major achievement--a 
major achievement. So the suggestion is, we ought to roll back and 
commit this bill. But that would eliminate the kind of investments we 
make in reducing the cost of prescription drugs or providing the kinds 
of benefits so people can get screenings and treat problems while they 
are still small.
  As a Senator, I have a health care plan that allows me to do that. I 
am 1 of 8 million people in this country who are Federal employees. We 
all get to do that. Why should a Senator's battle with cancer be more 
important than someone else's in this country? Why shouldn't every 
American male over the age of 50 be able to be screened to determine 
whether they might have prostate cancer?
  That is what we are talking about. That is what we are achieving in 
this bill. The idea that the status quo is OK is wrong. It is not OK. 
To say we ought to throw the bill back into committee, again--we all 
know what the meaning of that is, of course. It will mean an end to 
this legislation. Those are the facts.
  Fact No. 4, if you will: Rather than weaken Medicare, the health care 
reform will strengthen the financial status of the Medicare Program. 
That is from AARP. That is not some partisan conclusion.
  I say, respectfully, to our colleagues, and having been through this 
at great length over the summer, filling in for our friend whom we have 
now lost, Senator Kennedy, we went through long debates and discussions 
early on, a lot of bipartisan discussions. As I pointed out earlier, as 
to the bill that came out of the Health, Education, Labor, and Pensions 
Committee in the Senate, we conducted the longest markup in the history 
of that committee, going back decades, in order to listen to each other 
and to try to provide a bipartisan bill.
  In many ways, that bill is a bipartisan bill. It did not get 
bipartisan votes, unfortunately, coming out of committee. But the 
substance of the legislation includes the ideas and

[[Page 29054]]

thoughts of our colleagues across the political spectrum, and it is 
important the public know that during the debate.
  This is not a bill that was rushed through, jammed through. My 
colleague from Montana, Senator Baucus, spent weeks and weeks--months--
with Democrats and Republicans gathered around the table late into the 
evenings talking about how we can shape this bill on a bipartisan 
basis. I attended many of those meetings in his office. No one can 
accuse the Senator from Montana of not reaching out to the other side 
to be a part of this solution. He went beyond the extra mile to achieve 
that, and he was flatly turned down, regretfully, in that effort. But 
that should not be a reason why we do not try to move forward.
  I am still hoping we can get bipartisan support for the bill before 
it is concluded, but we will only get there if we work at it, and this 
is where we are working at it: on the floor of the Senate, and this 
debate is an opportunity to come forward and make constructive 
suggestions--not sending the bill back to committee, in effect, killing 
the legislation. That is the effect of what would happen if the McCain 
amendment were adopted.
  Rather than engage in this kind of debate back and forth, where the 
Republicans say Medicare gets cut and the Democrats say, no, it does 
not, I wished to share with my colleagues this morning what 
nonpartisan, outside groups say about this bill. Listen to those who 
have made an analysis of this bill who do not wear a partisan hat, who 
do not have a political label attached to their names but are viewing 
every syllable, every punctuation mark in the bill to determine what it 
does for people. The most important, significant organization that 
represents the interests of the elderly in this country has analyzed 
this bill and has said to America: This is a good bill. This bill 
strengthens Medicare, provides benefits, and reduces costs.
  That is what we have tried to achieve over these many months. So 
let's move on. If you want to cut this bill, if you want to change all 
this, then offer an amendment and let's vote on it, up or down, and 
move forward. I urge my colleagues to support this legislation and 
reject the McCain amendment because I think his proposal would do great 
damage to the effort we have achieved so far.
  With that, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Montana is 
recognized.
  Mr. BAUCUS. Mr. President, I noted that the other side, in the last 
couple, 3 days, has tried to make the case that seniors' Medicare 
benefits are in jeopardy because ``this legislation cuts Medicare.'' I 
have heard that statement over and over and over and over again. In 
fact, the last speaker on the other side made that same point.
  I am confounded, I am very surprised, when I hear those statements. 
Why am I very surprised? Because it is totally, patently false. It is 
false. It is untrue. There are no benefits cut here, none. One could 
say that with the private plans, the Medicare Advantage plans, which 
are vastly overpaid--the nonpartisan MedPAC organization states they 
are vastly overpaid by about 14 percent--one could say those private 
plans--it is not Medicare; those private plans, Medicare Advantage; 
those are not Medicare plans, those are private plans, private 
insurance plans--they may be overprescribing some nonguaranteed 
benefits for beneficiaries, things such as eyeglasses or something like 
that, which might be cut back. That is true. But none of the guaranteed 
benefits--the basic benefits under Medicare that every senior knows 
about when he or she goes to the doctor; and it is care under 
Medicare--is reduced. None. Nothing is cut.
  In fact, this legislation adds benefits to seniors. For example, it 
virtually fills up this thing we call the doughnut hole. That is the 
portion of prescription drug payments that seniors otherwise would have 
to pay. But we say $500 of that is going to be paid for, and the rest 
of it is going to be paid for at least for 1 more year. So that is an 
additional benefit. Then all the screening provisions that are in this 
bill, that is an additional benefit. There are many other benefits that 
are added onto the ordinary benefits seniors have.
  So it is not true--it is not true--that the basic guaranteed benefits 
under Medicare are cut. None of the guaranteed benefits under Medicare 
are cut--none. So it is totally untrue. It is false when people make 
the claim that ``Medicare is being cut.''
  They are being very clever, the people who are making those claims. 
What they are saying when they say Medicare will be cut--they want you 
to think they mean benefits will be cut--but deep in their mind, what 
they are holding back in their mind--well, when pressed, they will 
agree, well, it is the Medicare providers, it is the hospitals, it is 
the medical equipment manufacturers, it is the pharmaceutical industry. 
That is being cut. That is ``Medicare'' that is being cut and, 
therefore, that will hurt seniors. That is kind of the way they get 
around it.
  Well, the fact is, the way you preserve the solvency of the trust 
fund is to make sure there are not so many payments, frankly, by Uncle 
Sam going to pay for all the doctors and hospitals and so forth so the 
solvency of the trust fund is extended. Right now this legislation 
extends the solvency of the Medicare trust fund. If this legislation 
were not to pass, the Medicare trust fund would probably go insolvent 
in about the year 2017. But this legislation extends the solvency of 
the trust fund for at least 5 more years to 2022.
  So I wish to make it very clear that this legislation we are 
considering does not cut Medicare benefits. In fact, the hospitals and 
docs, I would say, are going to find at least a 5-percent increase in 
growth over the next 10 years in payments to them under the Medicare 
Program--growth. I have a chart which I showed yesterday on the floor. 
It showed, for each of the various years, it is a 5-percent increase in 
growth for all those industries. They are being cut 1.5 percent, but 
that is from a 6.5-percent growth, to net down to a 5-percent growth 
for each of the years.
  You ask analysts on Wall Street how hospitals are doing. They are 
doing great under this legislation. You ask analysts on Wall Street how 
the pharmaceutical industry is doing. They are doing great under this 
legislation. You ask any analyst about other industries--home health 
care, hospice care, you name it--they are all doing OK. Wall Street 
analysts say they are doing fine.
  Why are they doing fine? Why, objectively, are they doing fine? Why 
do the CEOs of these organizations not grumble too much? Because they 
know what they may lose in a little bit of a reduction in their 
payments--they will still get big, hefty payments--they will make up in 
volume because so many more people will have health insurance. They 
know that. They are going to make a lot of money. So they are OK.
  So it is not true that Medicare is going to go broke under this 
legislation. First of all, there is no reduction in benefits. That is 
very clear. Senator Dodd read a letter from AARP making that very 
clear. Also, the reductions are not reductions in provider payments; 
they are reductions in the rate of growth of provider payments, and 
they are going to do fine. Providers do not care that much because they 
are making it on volume because everybody is going to have health 
insurance. They have quite a bit--a 5-percent growth rate anyway. So it 
is not true--it is not true--that Medicare is in jeopardy because of 
this legislation. It is not true that benefits are going to be cut. In 
fact, just the opposite is true. This legislation strengthens benefits, 
increases benefits, extends the length of the Medicare trust fund to a 
future date further down the road, so it stays solvent for many years 
than otherwise is the case.
  This legislation helps seniors. It helps seniors, contrary to what 
you are hearing on the other side that it hurts seniors. If you just 
look at the facts, not the rhetoric--not the rhetoric but just look at 
the facts, look at the facts and look at who the supporters of this 
legislation are and objective groups and what they say about this 
legislation--you cannot help but be compelled

[[Page 29055]]

 to the conclusion that this legislation is not only good for seniors, 
it is very good for seniors.


                   Recognition of the Minority Leader

  The ACTING PRESIDENT pro tempore. The Republican leader is 
recognized.
  Mr. McCONNELL. Mr. President, with the apologies to my good friends 
from Montana and Connecticut, I was unavoidably detained at the opening 
and would like to now, on my leader time, give my opening remarks.
  The ACTING PRESIDENT pro tempore. The Senator has the floor.


                              Afghanistan

  Mr. McCONNELL. Mr. President, the challenges of the ongoing war in 
Afghanistan are immense, but Americans believe in the mission. They 
trust the advice of our commanders in the field to see that mission 
through.
  So I support the President's decision to follow the advice of General 
Petraeus and General McChrystal in ordering the same kind of surge in 
Afghanistan that helped turn the tide in Iraq.
  These additional forces will support a counterinsurgency strategy 
that will enable us to begin the difficult work of reversing the 
momentum of the Taliban and keeping it from power.
  The President is right to follow the advice of the generals in 
increasing troops, and he is also right to focus on increasing the 
ability of the Afghan security forces so they can protect the people.
  By doing both, he has made it possible for our forces to create the 
right conditions for Afghanistan--the right conditions for them to 
defend themselves, create a responsible government, and remain an ally 
in the war on terror.
  Although our forces are in Afghanistan to defend our security 
interests, the people of Afghanistan must assume a greater burden in 
the future. The President's plan recognizes that.
  Once we achieve our objectives--an Afghanistan that can defend 
itself, govern itself, control its borders, and remain an ally in the 
war on terror--then we can reasonably discuss withdrawal, a withdrawal 
based on conditions, not arbitrary timelines.
  But, for now, we owe it to the American people, to those who died on 
9/11, and to the many brave Americans who have already died on distant 
battlefields in this long and difficult struggle, to make sure 
Afghanistan never again serves as a sanctuary for al-Qaida. We owe it 
to the men and women who are now deployed or who will soon be deployed 
to provide every resource they need to prevail.


                           health care reform

  With every passing day, the American people become more and more 
perplexed about the Democratic plan for health care, and they like it 
less and less.
  Americans thought reform meant lowering costs. This bill actually 
raises costs. Americans thought reform meant helping the economy. This 
bill actually makes it worse. Americans thought reform meant 
strengthening Medicare. This bill raids it to create a new government 
program that will have the same problems that Medicare does. Americans 
wanted reform. What they are getting is the opposite--more spending, 
more debt, more burdens on families and businesses already struggling 
to get by.
  One of the biggest sources of money to pay for this experiment is 
Medicare. This bill cuts Medicare Advantage by $120 billion. It cuts 
hospitals by $135 billion. It cuts home health care by $42 billion. It 
cuts nursing homes by $15 billion. It cuts hospice by $8 billion.
  Reform shouldn't come at the expense of seniors. The McCain amendment 
guarantees it wouldn't. The McCain amendment would send this bill back 
to the Finance Committee with instructions to remove the language that 
cuts Medicare. The McCain amendment also says any funds generated from 
rooting out waste, fraud, and abuse should be used to strengthen 
Medicare, not to create an entirely new government program.
  A vote in favor of the McCain amendment is a vote to protect 
Medicare. Let me say that again. A vote in favor of the McCain 
amendment is a vote to protect Medicare. A vote against the McCain 
amendment is a vote to raid this vital program in order to create 
another one for an entirely new group of Americans. So a vote against 
the McCain amendment is a vote to take money out of Medicare to create 
a program for an entirely different set of Americans. A vote against 
the McCain amendment is a vote against our seniors, and it is a vote 
against real health care reform.
  Mr. President, I yield the floor.
  Mr. DODD. Mr. President, how much time remains?
  The ACTING PRESIDENT pro tempore. There is 13\1/2\ minutes.
  Mr. DODD. I yield myself 5 minutes, if I may. I want to go back, if I 
can. I wish to put up these charts. Again, I say this respectfully, 
because I genuinely believe that people across the spectrum want to see 
some reform of the health care system. The question is whether the 
proposal that has been laid before us by the Finance Committee and the 
HELP Committee achieves reform and whether the ideas we bring to the 
table are actually going to achieve lower costs, provide greater 
access, and improve the quality of health care. We believe very firmly 
and strongly that it does.
  There are outside observers of this process who have no political 
agenda whatsoever other than to make determinations as to whether the 
goals we have sought in this legislation achieve the desired results. 
It is the conclusion of the major organizations that make these 
determinations that, in fact, we have done exactly what we said we had 
set out to do.
  But I wish to point out, because I think it is important when I hear 
the arguments from our friends on the other side about their deep 
concerns about Medicare, it is very important they understand that over 
the last number of years, we have seen quite the opposite reaction when 
it comes to the Medicare Program in our Nation. Going back to 1995, 
when our friends took control of both this body and the other body, the 
then-Speaker of the House Newt Gingrich announced to the world that 
basically he was prepared to let Medicare ``wither on the vine.'' That 
is not ancient history. That is not 1965 when the Medicare Program was 
adopted; that is merely 14 years ago when the other party, for the 
first time in 40 years, became the dominant party here in Congress. One 
of the first statements from the leadership of that party was to let 
this program ``wither on the vine.'' Again, that is one person, the 
Speaker, the leader of the revolution that produced the results 
electorally in 1994. But I think it is important as a backdrop. When we 
hear the debate about Medicare, it is important to have some history 
about where the parties have been on this issue, generally speaking. So 
in 1995 we begin with that as a backdrop.
  In 1997, 2 years later, it happened again. In 1997, proposed Medicare 
cuts in the Republican Balanced Budget Act of that year were twice as 
much as the savings we are talking about in this bill. They proposed a 
12.4-percent reduction in Medicare benefits in 1997. Of course, the 
last budget submitted by President Bush last year--again, reflective of 
where things stand, and this is a year ago, not 14 years ago, and not 
1997, but 2009--the Bush administration in its submission of this 
budget proposed a $481 billion reduction in Medicare benefits. That was 
not in the context of a health reform bill; that was in the context of 
a budget proposal.
  Here we are talking about savings by reducing costs for hospitals and 
other providers as a way of strengthening Medicare, providing more 
benefits to the beneficiaries themselves through things such as 
prescription drugs as well as screenings and early prevention efforts 
which are included in our bill. Those things have been identified, of 
course, by AARP and the National Committee to Preserve Social Security 
and Medicare. They have analyzed our proposals and have suggested we do 
just that. We strengthen Medicare and we preserve those benefits. Our 
bill saves $380 billion in order to strengthen the Medicare proposal. 
It improves the quality of health care for seniors as part of our 
comprehensive reform. In fact, Senator Coburn's Patient Choice

[[Page 29056]]

Act actually imposes $40 billion more in cuts to Medicare Advantage 
than our bill does.
  I find it somewhat intriguing that those who are arguing for the 
Coburn proposal as an alternative and simultaneously suggesting we 
ought not to do anything to Medicare Advantage have not read the Coburn 
bill, because he cuts $40 billion more out of Medicare Advantage than 
we did in our legislation as proposed.
  In conclusion, let me quote from the National Committee to Preserve 
Social Security and Medicare--again, not a partisan organization. Their 
sole mission is to see to it that Social Security and Medicare will be 
there for the people it was intended to support. Let me quote exactly 
from a letter sent to every Senator yesterday from the committee:

       Not a single penny of the savings in the Senate bill--

  the bill now before us--

     will come out of the pockets of beneficiaries in the 
     traditional Medicare program. The Medicare savings included 
     in H.R. 3590, the Patient Protection and Affordable Care Act, 
     will positively impact millions of Medicare beneficiaries by 
     slowing the rate of increase in out-of-pocket costs and 
     improving benefits, and it will extend the solvency of the 
     Medicare trust fund by 5 years. To us, this is a win-win for 
     seniors and the Medicare program.

  So we can hear all of the partisan debate back and forth as to what 
this bill does, but if you are interested in what those organizations 
say, whose sole mission is to analyze whether beneficiaries are going 
to be advantaged or disadvantaged by what is being proposed here, they 
categorically, unequivocally, suggest that the McCain amendment does 
just the opposite of what our bill does. It would roll the clock back, 
damage seniors terribly by reducing or eliminating the provisions we 
have included in our bill, and they strongly support what the Finance 
Committee wrote in its bill that is now presented to all of us here as 
a way to strengthen and preserve the Medicare Program.
  I say to my colleagues and to others, you can listen to this partisan 
debate back and forth as to whether you want to believe the Democrats 
or believe the Republicans, but I would suggest if you are not clear 
who to believe in this, listen to the organizations whose job it is to 
protect this program, with whom we have worked very closely to 
determine that we would not in any way reduce those guaranteed benefits 
that Senator Baucus addressed in his remarks. That is what we do. That 
is why this bill is a good bill and deserving of our support. I urge 
our colleagues to reject the McCain amendment.
  Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Montana.
  Mr. BAUCUS. Mr. President, the Republican leader a few moments ago 
said this bill raises costs. With all due respect to my good friend 
from Kentucky, that statement is false.
  Just this week, the nonpartisan Congressional Budget Office, the 
organization that analyzes legislation--and both sides, both bodies 
depend on it; it is a very professional outfit, I might add--said our 
bill would reduce premiums, not increase but reduce premiums for 93 
percent of Americans. And for all Americans, it would make sure that 
better quality insurance is available.
  Let me state that a little bit differently. The Congressional Budget 
Office said that for 93 percent of Americans, premiums would be 
reduced. It is true that for 7 percent that is not the case. Those are 
Americans whose incomes are too high to qualify for subsidies; that is, 
the tax credits, buying insurance in exchange. But those 7 percent 
would get a lot better insurance, a lot higher quality insurance than 
they get today because of the insurance market reforms that are in this 
legislation. The provisions prevent insurance companies from denying 
coverage based on preexisting conditions, health status, the committee 
market rating provisions, no rescissions, et cetera. So for all 
Americans, it is true that this legislation will provide better quality 
insurance comparing apples with apples. There is a reduction for 93 
percent of Americans. The other 7 percent would be in the individual 
market and they would have a lot higher quality insurance. So if the 
quality is much higher, it would exceed the increase in premiums. They 
would be getting a better deal than they would otherwise be getting.
  CBO looked at this for the year 2016. They didn't look at it for 
other years, but at least that is the case for 2016: a reduction, not 
an increase but a reduction. In fact, for many in the nongroup market, 
those who individually buy insurance, they would find their premiums 
would be reduced about 40 or 50 percent. About 60 percent of those in 
the nongroup market are finding their insurance premiums would be 
reduced. I don't have the exact figure in front of me, but it is in the 
neighborhood of a 40- or 50-percent reduction in premiums. That is due 
to tax credits. Again, CBO says those tax credits would cover nearly 
two-thirds of premiums. So I guess I was a little conservative. It is a 
little more than 40 or 50 percent. It would cover two-thirds of 
premiums.
  CBO said those getting these tax credits would pay for roughly 56 
percent to 59 percent lower premiums than they would without our bill. 
Those are real savings. That is with respect to the premiums.
  What about out-of-pocket costs? This legislation has absolute limits 
on out-of-pocket costs. Today insurance companies can sell you a 
policy, you pay certain premiums, but there is no limit on the out-of-
pocket costs you might have to pay. Your deductible is so high, for 
example. This legislation puts an absolute limit so no policy can be 
sold that allows you to have out-of-pocket costs above a certain 
amount. I think it is $6,000 for an individual, and it might be double 
that for a family. But there is a limit. So this bill does not, as 
stated by the minority leader, raise costs. In fact, it reduces costs.
  In addition, there are many people who say, Oh, gosh, this is a $1 
trillion bill. Some people even say it is a $2.5 trillion bill. 
Senators on the other side of the aisle make those statements and they 
say this to try to scare us.
  I will be honest with you. I don't know if they believe it. They like 
saying it because it is a nice, good scare tactic. I say I am not sure 
they believe it. I wonder if they believe it, because when you read the 
legislation, it is deficit neutral. It does not add to the deficit.
  We have a budget resolution. Under that budget resolution, health 
care legislation for the next 10 years has to be deficit neutral. It 
cannot add one thin dime to the deficit. So I am a little curious when 
people talk about a $1 trillion bill. In fact, it reduces the deficit 
by $130 billion over a 10-year period. That is what the Congressional 
Budget Office says, the professional nonpartisan budget office.
  In the second 10 years, the CBO says our bill reduces the deficit by 
a one-quarter of 1 percent of the gross domestic product. That is 
roughly $\1/2\ trillion. In the second 10 years, this legislation 
reduces the deficit by $\1/2\ trillion. That is a reduction in the 
deficit.
  I don't know why these people are saying on the other side that this 
is a trillion-dollar bill. One said--and I will not mention his name--
the other day that this is a $2.5 trillion bill. That is not true. It 
is just not true because it is paid for. It would only be fair for them 
to say it is paid for. I think it is fair to get both sides of the 
story, not just one side. It does cost $1 trillion over 10 years, but 
it is more than paid for over 10 years. Those who say $2.5 trillion--
they start at 2014 up to 2020, and say that is why it costs so much. It 
is paid for during those years, too.
  Let me make it very clear this bill doesn't raise costs. In fact, it 
lowers costs, and the CBO says so. It doesn't add to the Federal 
deficit. In fact, it reduces the Federal deficit. I urge everyone to 
look at the facts closely whenever we hear statements made by anybody, 
including me. I urge people to listen to the words and read between the 
lines and see what is really going on. Like my father used to say: 
Don't believe everything you read and only half of what you hear. Take 
everything with a few grains of salt.
  The PRESIDING OFFICER (Mr. KIRK). The Senator from Tennessee is 
recognized.

[[Page 29057]]


  Mr. ALEXANDER. Mr. President, I agree with the Senator. That is why 
we have 22 minutes on the Republican side to clear up some 
misconceptions.
  The Democratic health care bill does cost $2.5 trillion over 10 years 
when it is fully implemented. If I may say so, it is arrogant to think 
the American people couldn't figure out the difference between the 
first 10 years, when the bill wasn't implemented in 4 of those years, 
and they would like to know that it costs $2.5 trillion.
  Mr. BAUCUS. Will the Senator yield for a question?
  Mr. ALEXANDER. If it is on your time.
  Mr. BAUCUS. Is it paid for?
  Mr. ALEXANDER. The Senator is right. It is paid for by cutting 
grandma's Medicare. It is paid for by cutting grandma's Medicare by 
$465 billion over a 10-year period of time, and about $500 billion in 
taxes----
  Mr. BAUCUS. That is a second question I would love to debate with the 
Senator. But on the first question only, the Senator admits it is paid 
for?
  Mr. ALEXANDER. No. I admit it costs $2.5 trillion, and the attempt to 
pay for it is through Medicare cuts, tax increases, and increases to 
the deficit by not including the physician reimbursement in the health 
care bill.
  Mr. BAUCUS. One more question. I think we all know the House has 
taken action on physician reimbursement, and the Senate will also do so 
before we adjourn. That is the so-called doc fix. That is a separate 
issue. That will be paid for. Putting the doctor issue aside, health 
care reform--and I say that because we take up the doc fix virtually 
every year. We don't take up health care reform every year. That is an 
entirely separate proposition, separate legislative endeavor.
  If the Senator will bear with me and take the doc fix off the table 
for a second--we can address that later--health care reform--to use a 
10-year number, or when you start in 2010 or in 2014, wherever you are 
starting--either there is $1 trillion or $2.5 trillion, depending where 
you start, not getting into how it is paid for. Is it paid for and 
therefore it is not deficit; am I not correct?
  Mr. ALEXANDER. I will concede to the Senator from Montana that the 
attempt of the Democrats to pay for this $2.5 trillion bill consists of 
Medicare cuts, tax increases, and additions to the deficit by not 
including the physician reimbursement, which is an essential part of 
any 10-year health care plan. There may be other problems, but those 
are the three things I know about.
  Mr. BAUCUS. One more question on my time. Is it true there are no 
cuts in guaranteed beneficiary payments--none whatsoever--in this 
legislation--in guaranteed benefits?
  Mr. ALEXANDER. I would say no to that, Mr. President, because the 
Director of the Congressional Budget Office made it clear there would 
be specific cuts in benefits for those who have Medicare Advantage, 
which is about one out of four seniors.
  Mr. BAUCUS. Is it true those provisions are not guaranteed 
provisions? I am talking about guaranteed benefits that seniors expect 
to get when they go to the doctor, fee for service, expected benefits, 
under ordinary Medicare, not benefits that a private plan may pay in 
addition.
  Mr. ALEXANDER. Mr. President, it is clear there are $465 billion in 
cuts in Medicare. The Chair and the Senator from Montana and the 
Senator from Connecticut have all agreed that is a big part of how the 
bill is supposedly paid for. It is specific enough to say that $135 
billion comes from hospitals; $120 billion from Medicare Advantage, 
which 11 million seniors have; nearly $15 billion from nursing homes; 
$40 billion from home health agencies; $8 billion from hospices.
  The Director of the CBO testified that provisions like that would 
result in specific cuts to benefits for Medicare Advantage. He said 
that fully half of the benefits currently provided to seniors under 
Medicare Advantage would disappear. The changes would reduce the extra 
benefits, such as dental, vision, and hearing coverage, that currently 
are made available to beneficiaries.
  Mr. BAUCUS. One more question. Does the Senator agree this 
legislation will extend the solvency of the Medicare trust fund for 5 
years, and failure to pass this would mean the solvency of the Medicare 
trust fund would not be extended for 5 years?
  Mr. ALEXANDER. I wholeheartedly disagree with that. The Medicare 
trustees have said that between 2015 and 2017 Medicare will be 
approaching insolvency. They have asked that we take urgent action. The 
urgent action recommended by the Democratic majority is that we take 
$465 billion out of the Medicare Program over 10 years and spend it on 
a new entitlement.
  It is hard for me to understand how that can make Medicare more 
solvent, when you take money out of grandma's Medicare and spend it on 
someone else.
  Mr. McCAIN. Will the Senator yield?
  Mr. ALEXANDER. Yes.
  Mr. McCAIN. Isn't it, shall we say, Enron accounting when you have a 
proposal that, as soon as the bill becomes law, you begin to raise 
taxes and cut benefits, and then you wait 4 years before any of the 
benefits are then extended to the beneficiaries? That, on its face, is 
a remarkable piece of legislation. My experience, which has only been 
20-some years, is that we haven't passed legislation that says we are 
going to collect taxes on it for 4 years, and then we are going to give 
you whatever benefits that may accrue from this legislation. Again, 
there has been no time in history where we have taken money from an 
already failing system to create a new entitlement program.
  Mr. BAUCUS. Which colleague is the Senator asking that?
  Mr. McCAIN. I believe the Senator from Tennessee has the floor.
  Mr. BAUCUS. He does.
  Mr. McCAIN. I was addressing the person who has the floor, which I am 
sure the Senator from Montana should understand by now.
  Mr. ALEXANDER. I say to the Senator from Arizona that he is exactly 
right. Another way to describe it, the Senator from Kansas said it was 
like writing a big check on an overdrawn bank account and buying a big 
new car. Maybe another way, if I may respond to the Senator from 
Arizona--I ask unanimous consent that Republican Senators, on our time, 
be allowed to engage in a colloquy.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. BAUCUS. May I ask the Senator another question?
  Mr. ALEXANDER. I would like to finish responding to Senator McCain, 
if I might.
  Mr. BAUCUS. Then I have a question on the same subject.
  Mr. ALEXANDER. I hope the Parliamentarian is keeping track of the 
Republican time. I am enjoying the questioning, and I thank the Senator 
for his question. One of the things--in fact, a great compliment has 
been paid to the Senator from Arizona. It is rare that a Senator can 
have something he said actually begin to break through the fog.
  Dana Milbank, a columnist for the Washington Post, wrote a column 
about it being all about grandma and wondering why we never mention 
grandpa. Maybe Mr. Milbank hasn't seen the movie ``My Big Fat Greek 
Wedding,'' where the man said, ``I'm the head of the house,'' and the 
woman said, ``I'm the neck, because I can turn the head any way I 
want.''
  We are talking about grandma because she can help persuade grandpa. 
If we take $465 billion out of Medicare over 10 years, grandma and 
grandpa and those who are younger and looking forward to Medicare will 
be affected.
  If I may say to the Senator from Arizona--and I see the Senator from 
Oklahoma and the Senator from Nebraska--it wasn't long ago, in response 
to the question--in fact, in 2005, when we sought to restrain the 
growth of Medicare by $10 billion over 5 years, and this is what they 
said--remember, they are ``restraining'' the growth of Medicare by $465 
billion and spending it on a new program, and Republicans were, at that 
time, trying to save $10 billion over 5 years.
  ``An immoral document,'' said Senator Reid and Senator Dodd. The 
Senator from Connecticut said that funding for Medicare would be cut. 
Senator

[[Page 29058]]

Rockefeller: ``A moral disaster of monumental proportion.'' Senator 
Boxer, in the same way, compared it to Katrina. Senator Kerry said we 
are ``passing the costs on to seniors.'' Senator Levin said people are 
``going to be hurt by this bill.'' ``Irresponsible and cruel,'' said 
Senator Kohl. Senator Reed and Senator Hillary Clinton also made 
similar comments.
  That was for $10 billion of restraining the growth of Medicare to 
spend it on the existing program. Yet this proposal by the Democrats 
would take $465 billion and spend it on a new program.
  Mr. McCAIN. Isn't it true--and the Senator from Montana is on the 
Senate floor and wants to enter into this. Maybe he can respond to his 
comments of 14 years ago. We weren't trying to create a new entitlement 
program, which is the object of the Senator's bill. We were just trying 
to enact some savings in the Medicare system.
  What did Senator Baucus say? He said:

       And above all, we must not use Medicare as a piggy bank.

  What are we using the $483 billion in cuts in Medicare for?
  Then he said:

       That is disgraceful. Perhaps some changes lie ahead. But if 
     they do, they should be made for the single purpose of 
     keeping Medicare services for senior citizens and people with 
     disabilities.

  Isn't it true that now that we are taking $483 billion out of a 
failing system the Medicare trustees say is going to go bankrupt, and 
the Senator from Montana, 14 years ago, said:

       Seniors could easily be forced to give up their doctor, as 
     doctors begin to refuse Medicare patients and hospitals--
     especially rural hospitals--close.

  Isn't that the effect of taking $483 billion in cuts in Medicare? 
Then the Senator from Montana went on to say:

       Equivalent to blowing up the house and erecting a pup tent 
     where it used to be.

  Instead of blowing up a pup tent, I would say what they are doing is 
like a hydrogen bomb. Finally, Senator Baucus said:

       Staggering. The leadership now proposes something like $250 
     billion in Medicare cuts. It is staggering. It is a reduction 
     of nearly a quarter in Medicare services by the year 2002.

  All of us here learn about the issues. Apparently, the Senator from 
Montana didn't learn much, because he was deeply concerned 14 years ago 
about a very small savings in Medicare. Now he wants to spend $2.5 
trillion and taking $483 billion out of Medicare to create a new 
entitlement system.
  Mr. BAUCUS. Might I respond to the Senator?
  Mr. ALEXANDER. Mr. President, I am happy to see a debate actually 
break out on the Senate floor on this issue.
  Mr. BAUCUS. Here is your opportunity; here is your chance.
  Mr. ALEXANDER. As long as it is on Democratic time.
  Mr. BAUCUS. It is on both sides. We have even time.
  Mr. ALEXANDER. I mean whatever time the Senator uses should be on 
Democratic time.
  Mr. BAUCUS. Yes. The basic question, obviously, is how to protect 
Medicare benefits. I think most of us would say how do we protect 
Medicare benefits and extend the solvency of the Medicare trust fund. I 
think we would all agree that excessive payments to providers would 
cause insolvency of the trust funds to come earlier rather than later. 
We all agree with that proposition.
  The next question is, What would excessive payments to providers be? 
Do providers get paid excessively? I think that is an honest question 
we should ask ourselves in a way to help extend the solvency of the 
Medicare trust fund. In fact, in 1995, many Senators, especially on the 
other side of the aisle, did say just that, that we have to cut 
Medicare in order to save benefits. That was made by many Senators. I 
have them right in front of me, if anybody wants to hear them. I am not 
going to go through all of that, but it is the truth. That is exactly 
what we are doing in this bill. We are trying to help extend the 
solvency of the Medicare trust fund by cutting down on excessive 
provider payments from the Medicare trust fund.
  How do we decide whether payments are excessive? That is the basic 
question here. All we can do is just give it our best shot, make our 
best judgment. I think it makes sense to look at the recommendations by 
outside independent groups, what they think. One is MedPAC, the 
Medicare Payment Advisory Commission. That is an outside group, as we 
all know, that advises Congress on Medicare payments. As Members of 
Congress, we are not totally competent to know exactly what dollars 
should go to which industry group. We have too many other obligations 
to think about. As Senators, we must be responsible to do the best we 
can. MedPAC has said these groups have been overpaid. And Wall Street 
analysts tend to agree. In fact, MedPAC said, with respect to Medicare 
Advantage, that they have been overpaid--I forget the exact amount but 
much less than the $118 billion reduction in this bill.
  In fact, I totaled up and looked at the projected growth rate of 
providers--hospitals, nursing homes, home health, hospice, PhRMA, you 
name it--and on average their growth rate over the next decade is going 
to be 6\1/2\ percent. That is the growth rate of providers. We decided 
to trim that a little bit by 1.5 percent. So it is 5 percent. It is a 
5-percent growth rate in an attempt to try to find the right levels of 
reimbursement to providers, which will also help extend the solvency of 
the Medicare trust fund.
  When we talk to providers, they basically agree with those cuts. They 
basically agree. Why do they basically agree? They basically agree 
because they know that with much more coverage, with many more people 
having health insurance, they could spread out their business. They may 
lose a little on margin, but they can pick it up on volume. That is 
exactly what their business plan is under this bill.
  Wall Street analysts say--I quote them--these industries are doing 
great, they are doing well under this bill. They are not getting hurt. 
So we do achieve a win-win--I don't like that phrase, by the way, but I 
will use it here--where the solvency of the trust fund is being 
extended and where reimbursement rates to providers are fair--not being 
hurt; it is fair. And that is why they want this bill, by and large.
  Most groups tend to want this bill enacted because they know it is 
good for the country, it is good for the seniors, and it is good for 
them too.
  Mr. McCAIN. Mr. President, may I just mention again, $70 billion in 
fraud, abuse, and waste, and Senator Coburn, the doctor, can tell you, 
that is nowhere in this bill. The fact is, maybe some of the providers 
have been bought off, jawboned, or had their arms twisted or given a 
good deal, like PhRMA has. Recipients have not. Medicare recipients 
know you cannot cut $483 billion without ultimately affecting their 
benefits, and that is a fact.
  Again, conspicuous by its absence, I say to the Senator from Montana, 
totally conspicuous by its absence is any meaningful malpractice 
reform, which has been proven in the State of Texas and other States to 
reduce costs and to increase the supply of physicians and caregivers. 
There is nothing in this bill that is meaningful about medical 
malpractice reform.
  I had a townhall meeting with doctors in my State, and everyone stood 
up and said: I practice defensive medicine because I fear being sued.
  If you are really serious, I say to the Senator from Montana, if you 
are really serious about this, medical malpractice should be a key and 
integral part of it. Even the CBO costed it out at about $54 billion a 
year. When you count in all the defensive medicine, it could be as much 
as $200 billion over 10 years. That is conspicuous by its absence. I 
think it brings into question the dedication of really reducing health 
care costs across America.
  Mr. ALEXANDER. Mr. President, we have enjoyed our discussion with the 
distinguished chairman of the Finance Committee and thank him for his 
questions.
  Senator Coburn, who is a physician--the Senator from Montana talked 
about doctors being overpaid. He talked about----

[[Page 29059]]


  Mr. BAUCUS. No, no, no, I did not. With all due respect, I did not 
say that.
  Mr. ALEXANDER. Didn't I hear the words ``providers overpaid''?
  Mr. BAUCUS. I talked about hospitals. I did not talk about doctors 
overpaid. If I may say to my friend from Tennessee, this legislation 
pays more to primary care doctors, a 10-percent increase in Medicare 
reimbursement for each of the next 5 years. I did not say ``doctors.''
  Mr. ALEXANDER. I must have misunderstood. Normally when we talk about 
providers, we talk about hospitals and physicians.
  We have a physician on the Senate floor, the Senator from Oklahoma. I 
wonder if he, having heard this debate, might want to comment. I might 
say, isn't it true that the McCain motion, which we have on the floor, 
would send this back to the Finance Committee and say: If there are 
savings, let's spend it on Medicare to actually strengthen it?
  Mr. COBURN. Mr. President, I thank the Senator. The first comment I 
have is about relying on what Wall Street analysts say today. They have 
about this much credibility in this country today. Look at the economic 
situation we find ourselves in because of what Wall Street analysts 
have said. That is the first point I would make.
  The second point is that the majority whip yesterday said we should 
cut Medicare Advantage because of the 14 percent. Senator Dodd just 
recently went after the Patients' Choice Act because we actually make 
it be competitively bid without any reduction in benefits. Your bill, 
for every Medicare Advantage, cuts 50 percent of the benefits out. It 
cuts the benefits.
  The difference is--and I agree with the majority whip--we do need to 
have the savings in Medicare Advantage, but the way you get that is 
through competitively bidding it while at the same time maintaining the 
requirements for the benefits that are offered. There is a big 
difference in those two. Ours ends up being pure savings to save 
Medicare. The savings in this bill are to create a new entitlement.
  The other point I wish to make is, if you are a senior out there 
listening and if you are going to be subject to the new increase in 
Medicare tax, for the first time in history, we are going to take the 
Medicare tax and not use it for Medicare, we are going to use it for 
something else under this bill. This one-half of 1 percent is now going 
to be consumed in something outside of Medicare. So no longer do we 
have a Medicare tax for the Medicare trust fund. We have a Medicare tax 
that funds the Medicare trust fund plus other programs.
  I say to my colleagues, I think we want a lot of the same things. How 
we go about it--the Senator from Montana recognized the fact that we 
are going to increase payments to primary care physicians. Ask yourself 
the question why only 1 in 50 doctors last year who graduated from 
medical school is going into primary care. Why do you think that is? 
Could it be that the government that is setting the payment rates 
created a maldistribution in remuneration to primary care physicians; 
therefore, they choose to go where they can make 200 percent more over 
their lifetime by spending 1 additional year in residency rather than 
doing primary care?
  What this bill does, and what the Senator from Arizona is trying to 
do by sending this bill back, is to refocus it on the fact that 
Medicare money ought to be used for Medicare. If, in fact, we are going 
to slow the growth of Medicare, can we do that without cutting 
benefits? To slow the growth in this bill for 11 million Americans who 
now have Medicare Advantage will diminish their benefits. That is out 
of the $120 billion that is going to come.
  You cannot tell a senior who is in a rural area today, who is on the 
economic lower rungs of the ladder, who uses Medicare Advantage to 
equalize their care with somebody who can afford a Medicare 
supplemental policy, you cannot tell them this is not going to decrease 
their benefits and their care, because it is. And in the bill, it 
actually states that it is going to decrease their benefits.
  Mr. McCAIN. Will the Senator yield? Very briefly, the Senator from 
Montana talked about the support the bill gets. AARP makes more money 
from Medigap plans they sell to seniors. AARP should be opposing the 
bill, but other groups such as 60 Plus are educating seniors.
  The AMA endorsement of the bill--shocking. The bill puts the 
government in charge, but AMA cut a deal to get their Medicare payments 
addressed by increasing the deficit by $250 billion.
  Mr. COBURN. Mr. President, will the Senator yield for a minute?
  Mr. McCAIN. PhRMA--my God, if there ever was an obscene alliance made 
that will harm seniors because it has the administration against drug 
reimportation from Canada and competition for treatment of Medicare 
patients.
  So now we understand a little bit better why these special interest 
groups, 500-some of them, have visited the White House in recent 
months, according to White House logs.
  Mr. COBURN. The Senator would probably be interested to know--and, I 
know, my colleagues on the other side--that the American Medical 
Association now represents less than 10 percent of the actively 
practicing physicians in this country. The physicians as a whole in 
this country are adamantly opposed to this bill. The reason they are 
opposed to this bill is because you are inserting the government 
between them and their patient. That is why they are opposed to this 
bill.
  So you have the endorsement of the AMA which represents less than 10 
percent of the practicing doctors--actively practicing doctors--in this 
country because not only will it increase payments, but CPT code 
revenue is protected. That is the revenue AMA gathers from the payment 
system that continues to be fostered in this bill, which is their main 
source of revenue.
  Mr. McCAIN. May I ask my colleague's indulgence for just a moment 
because, as you know, the majority leader seems to appear more and more 
frantic as he, perhaps, is reading the same polls we are that more and 
more Americans, when they figure out this legislation, are becoming 
more and more opposed to it.
  Yesterday, the majority leader came out and directly addressed me, 
saying:

       This man talks about earmarks, but his amendment is one big 
     earmark to the insurance industry. And in addition to that, 
     the sponsor of the amendment--

  Talking about me--

     during his Presidential campaign talked about cutting these 
     moneys.

  Mr. President, I hate, I say to my colleagues, to take a trip back 
down memory lane, but at the time--of course, this was echoed by a DNC 
spokesperson, who then echoed it throughout the blogosphere and 
leftwing liberal blogs. The fact is, on October 20, FactCheck.org says:

       He accuses McCain of proposing to cut benefits. Not true.

  This is from FactCheck.

       In a TV ad and in speeches, Obama is making bogus claims 
     that McCain plans to cut $880 billion from Medicare spending 
     and to reduce benefits.
       A TV spot says--

  A very well-funded campaign, I might add--

       McCain's plan requires ``cuts in benefits, eligibility, or 
     both.''
       Obama said in a speech that McCain plans ``cuts'' that 
     would force seniors to ``pay more for your drugs, receive 
     fewer services, and get lower quality care.''
       A second ad claims that McCain's plan would bring about a 
     22 percent cut in benefits.

  FactCheck.org says:

       These claims are false, and based on a single newspaper 
     report that says no such thing. McCain's policy director 
     states unequivocally that no benefit cuts are envisioned.

  Mr. President, I ask unanimous consent to have printed in the Record 
the entire FactCheck.org article.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                      Obama's False Medicare Claim


                                Summary

       In a TV ad and in speeches, Obama is making bogus claims 
     that McCain plans to cut $880 billion from Medicare spending 
     and to reduce benefits.

[[Page 29060]]

       A TV spot says McCain's plan requires ``cuts in benefits, 
     eligibility or both.''
       Obama said in a speech that McCain plans ``cuts'' that 
     would force seniors to ``pay more for your drugs, receive 
     fewer services, and get lower quality care.''
       Update, Oct. 21: A second Obama ad claims that McCain's 
     plan would bring about a 22 percent cut in benefits, ``higher 
     premiums and co-pays,'' and more expensive prescription 
     drugs.
       These claims are false, and based on a single newspaper 
     report that says no such thing. McCain's policy director 
     states unequivocally that no benefit cuts are envisioned. 
     McCain does propose substantial ``savings'' through such 
     means as cutting fraud, increased use of information 
     technology in medicine and better handling of expensive 
     chronic diseases. Obama himself proposes some of the same 
     cost-saving measures. We're skeptical that either candidate 
     can deliver the savings they promise, but that's no basis for 
     Obama to accuse McCain of planning huge benefit cuts and more 
     expensive prescription drugs, and claims that both nursing 
     home care and a patient's choice of doctor could be affected.


                                Analysis

       As the narrator says that McCain's plan ``means a 22 
     percent cut in benefits,'' the ad displays a footnote citing 
     an Oct. 6 Wall Street Journal story as its authority.
       But, in fact, the Journal story makes no mention of any 22 
     percent reduction, or any reduction at all. To the contrary, 
     the story's only mention of what might happen to benefits is 
     a quote from McCain adviser Douglas Holtz-Eakin promising to 
     maintain ``the benefit package that has been promised.'' The 
     story quotes him as saying ``savings'' would come from 
     eliminating Medicare fraud and by reforming payment policies 
     to lower the overall cost of care.
       The fact is that McCain has never proposed to cut Medicare 
     benefits, or Medicaid benefits either. Obama's claim is based 
     on a false reading of a single Wall Street Journal story, 
     amplified by a one-sided, partisan analysis that piles 
     speculation atop misinterpretation. The Journal story in turn 
     was based on an interview with McCain adviser Holtz-Eakin. He 
     said flatly in a conference call with reporters after the ad 
     was released, ``No service is being reduced. Every 
     beneficiary will in the future receive exactly the benefits 
     that they have been promised from the beginning.''


                    Twisting Facts to Scare Seniors

       Here's how Democrats cooked up their bogus $882 billion 
     claim.
       On Oct. 6, the Journal ran a story saying that McCain 
     planned to pay for his health care plan ``in part'' through 
     reduced Medicare and Medicaid spending, quoting Holtz-Eakin 
     as its authority. The Journal characterizes these reductions 
     as both ``cuts'' and ``savings.'' Importantly, Holtz-Eakin 
     did not say that any benefits would be cut, and the one 
     direct quote from him in the article makes clear that he's 
     talking about economies:
       Wall Street Journal, Oct. 6: Mr. Holtz-Eakin said the 
     Medicare and Medicaid changes would improve the programs and 
     eliminate fraud, but he didn't detail where the cuts would 
     come from. ``It's about giving them the benefit package that 
     has been promised to them by law at lower cost,'' he said.
       Holtz-Eakin complains that the Journal story was ``a 
     terrible characterization'' of McCain's intentions, but even 
     so it clearly quoted him as saying McCain planned on ``giving 
     [Medicare and Medicaid beneficiaries] the benefit package 
     that has been promised.''
       Nevertheless, a Democratic-leaning group quickly twisted 
     his quotes into a report with a headline stating that the 
     McCain plan ``requires deep benefit and eligibility cuts in 
     Medicare and Medicaid''--the opposite of what the Journal 
     quoted Holtz-Eakin as saying. The report was issued by the 
     Center for American Progress Action Fund, headed by John D. 
     Podesta, former chief of staff to Democratic President Bill 
     Clinton. The report's authors are a former Clinton 
     administration official, a former aid to Democratic Sen. Bob 
     Kerrey and a former aid to Democratic Sen. Barbara Mikulski.
       The first sentence said--quite incorrectly--that McCain 
     ``disclosed this week that he would cut $1.3 trillion from 
     Medicare and Medicaid to pay for his health care plan.'' 
     McCain said no such thing, and neither did Holtz-Eakin. The 
     Journal reporter cited a $1.3 trillion estimate of the amount 
     McCain would need to produce, over 10 years, to make his 
     health care plan ``budget neutral,'' as he promises to do. 
     The estimate comes not from McCain, but from the Urban-
     Brookings Tax Policy Center. McCain and Holtz-Eakin haven't 
     disputed that figure, but they haven't endorsed it either.
       Nevertheless, the report assumes McCain would divide $1.3 
     trillion in ``cuts'' proportionately between the two 
     programs, and comes up with this: ``The McCain plan will cut 
     $882 billion from the Medicare program, roughly 13 percent of 
     Medicare's projected spending over a 10-year period.'' And 
     with such a cut, the report concludes, Medicare spending 
     ``will not keep pace with inflation and enrollment growth--
     thereby requiring cuts in benefits, eligibility, or both.''
       The Obama campaign began the Medicare assault with a 30-
     second TV ad released Oct. 17, which it said would run 
     ``across the country in key states.''
       Announcer. John McCain's health care plan . . . first we 
     learned he's going to tax health care benefits to pay for 
     part of it.
       Now the Wall Street Journal reports John McCain would pay 
     for the rest of his health care plan ``with major reductions 
     to Medicare and Medicaid.''
       Eight hundred and eighty-two billion from Medicare alone. 
     ``Requiring cuts in benefits, eligibility, or both.''
       John McCain . . . Taxing Health Benefits . . . Cutting 
     Medicare. We Can't Afford John McCain.
       Obama. I'm Barack Obama and I approved this message.
       The ad quotes the Wall Street Journal as saying McCain 
     would pay for his health care plan with ``major reductions to 
     Medicare and Medicaid,'' which the ad says would total $882 
     billion from Medicare alone, ``requiring cuts in benefits, 
     eligibility, or both.''
       Obama elaborated on the theme Oct. 18 in a stump speech in 
     St. Louis, Mo., claiming flatly that seniors would face major 
     medical hardships under McCain:
       Obama, Oct. 18: But it turns out, Senator McCain would pay 
     for part of his plan by making drastic cuts in Medicare--$882 
     billion worth. Under his plan, if you count on Medicare, you 
     would have fewer places to get care, and less freedom to 
     choose your doctors. You'll pay more for your drugs, receive 
     fewer services, and get lower quality care.
       Update, Oct. 21: A second and even more misleading Obama ad 
     begins: ``How will your golden years turn out?'' It states 
     flatly that McCain's plan would mean a 22 percent cut in 
     benefits, higher premiums, higher co-pays, . . .

  Mr. McCAIN. Mr. President, I hope the Senator from Nevada will stop 
making false claims--repeating the false claims that were in attack ads 
on me throughout the campaign, funded by tens of millions of dollars, 
about my positions on health care in America which the fact checkers 
found to be totally false.

       As the narrator says that McCain's plan ``means a 22 
     percent cut in benefits,'' the ad displays a footnote citing 
     an Oct. 6 Wall Street Journal story as its authority.

  FactCheck:

       But, in fact, the Journal story makes no mention of any 22 
     percent reduction, or any reduction at all.

  I hope, among other things, in his, may I describe, frustration, that 
the Senate majority leader would at least not repeat false accusations 
about what I wanted to do in the Presidential campaign. It is 
unfortunate.
  And I hope that maybe, instead of attacking David Broder, instead of 
attacking me, instead of attacking others who are in support of this 
amendment, maybe we could have a more meaningful discussion about the 
facts surrounding this legislation.
  Mr. DODD. Mr. President, may I inquire how much time remains on both 
sides?
  The PRESIDING OFFICER. Thirty seconds remains for the minority.
  Mr. DODD. The minority has 30 seconds.
  The PRESIDING OFFICER. The Senator from Nebraska.
  Mr. JOHANNS. Mr. President, I will speak very quickly, since we have 
30 seconds.
  Reality does set in. We have looked at the impact of these cuts on 
our nursing home beds in Nebraska. We have about 14,000 beds dedicated 
to Medicare. This will be a loss of $663 per bed. That affects real 
people.
  I thank the Chair.
  The PRESIDING OFFICER. The minority's time has expired.
  Mr. DODD. Mr. President, I yield 2 minutes of our time to the Senator 
from Nebraska.
  Mr. JOHANNS. I thank the Senator. That is very kind of you, and I 
appreciate that.
  Maybe it comes from my time as Governor, maybe it comes from my time 
as mayor, but somehow, some way, you have to live with the legislation 
that is passed, whether it is by the Federal Government, whether it is 
at the State level or whatever. You can bounce this back and forth all 
day, but the reality is these are real cuts and they involve real 
programs that involve real people in our States. You can describe them 
any way you want, you can call them excessive payments, you can do 
this, that, or the next thing. You can say: Well, we are giving this 
our best shot, but the difficulty is

[[Page 29061]]

this is a high-risk venture. We will be impacting in my State, for 
example--and every Senator could stand up and give this same speech--
but this will impact the most vulnerable population in our Nation--
people who are in a nursing home and who are the Medicare 
beneficiaries.
  As I said in my short statement, there are 14,061 nursing home beds 
across our State that are dedicated to Medicare patients. We are 
working overtime to try to understand what this legislation does to 
real people. The number we have come up with, working with our nursing 
home industry, is that if this legislation is passed, each bed is 
impacted by a loss of $663.
  I will sum up my comments by reading something that was sent to me by 
someone who works in the nursing home industry. Here is what this 
person says:

       For the first time in my career, I am honestly questioning 
     how much longer I can continue. To constantly be up against 
     regulation and funding, when all you want to do is make a 
     difference in someone's life, is exhausting.

  This is a high-risk venture. This shouldn't be about taking our best 
shot, this should be about getting this legislation right.
  I thank the Chair.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. DODD. Mr. President, let me, if I can, address a couple of 
points. First of all, I made this point yesterday, but it deserves 
being made again because the suggestion somehow that this bill doesn't 
provide any benefits to anyone until the year 2014 is untrue. I could 
spend the next 40 minutes describing the various things our bill does 
immediately. Upon the enactment of this legislation, there are tax 
breaks immediately for small businesses to be able to reduce the cost 
of health care in a market where small businesses pay, on average, 18 
percent more for health care premiums than other businesses do. As 
pointed out by the CBO, under our bill you are actually seeing premium 
cost reductions in the small business market, as well as the individual 
market and the large-group market.
  Right away our legislation closes a good part of that doughnut hole, 
which is an immediate benefit to the cost of prescription drugs for the 
elderly. That doesn't happen 4 or 5 years from now, but immediately.
  We provide immediate screening and prevention services for Americans. 
As I mentioned earlier, that is not only the humane thing to do, it is 
also a great cost saver. If you can detect an early problem and deal 
with it, the cost savings are monumental, and we all know that.
  Under our health care plans as Senators--where we get 23 different 
options every year to choose from--we have that benefit. I am a 
beneficiary of that benefit, having identified a health care problem 
early through screening. That was not only beneficial to me personally, 
because I am going to be alive for a longer period of time than 
otherwise, but it saved thousands of dollars in long-term medical costs 
that would have occurred if I had not identified the problem. Those are 
simple things that are included in our bill that happen immediately.
  You can't be dropped by your health care carrier, as you are today. 
Today, you can be dropped for no cause--for no reason whatsoever. That 
is stopped immediately on the adoption of this legislation.
  So when I heard my good friend from Arizona saying there are no 
benefits in this bill for 4 or 5 years, that is not true. And again, a 
simple reading of the legislation would identify any number--I have 
here a long list--of benefits that will happen immediately.
  The issue Senator Baucus has raised over and over again is the issue 
of guaranteed benefits under Medicare. Guaranteed benefits. Let me 
challenge my colleagues to identify a single guaranteed benefit under 
Medicare that is cut by the bill before us. There is not a single 
benefit under the guaranteed program that is in any way disadvantaged 
or reduced as a result of this legislation. What is cut are private 
health care plans under the Medicare Advantage Program. The reason why 
we are doing this is Medicare Advantage overpayments cost every senior 
more money. A typical elderly couple pays $90 more per year in Part B 
premiums to pay for the Medicare Advantage overpayments, even if they 
are not enrolled in these plans. That is $90, on average, for every 
couple, and they get none of the benefits from it. Fully 78 percent of 
beneficiaries are forced to pay higher premiums for non-Medicare extra 
benefits they will never see.
  Again, I understand some people would like to have these additional 
benefits. I understand that. They are not guaranteed Medicare benefits. 
These are benefits that are provided for under Medicare Advantage. But 
78 percent of our elderly are paying higher premiums so a smaller 
percentage of people can get those benefits. Why should 78 percent of 
the elderly in this country pay a higher premium for a smaller 
percentage of people under private health care plans?
  What Senator Baucus and the Finance Committee tried to do is to 
reduce those costs. Those are not guaranteed Medicare benefits. There 
is no guaranteed Medicare benefit that is cut under this bill, and I 
defy any Member of this body to find one guaranteed benefit that is 
reduced under this plan.
  Mr. BURR. Will the Senator yield for a question?
  Mr. DODD. I will be happy to yield to my friend.
  Mr. BURR. I would ask the distinguished Senator from Connecticut if 
we empower the independent Medicare advisory board to come up with 
$23.4 billion in cuts under Medicare? Can the Senator from Connecticut 
assure me that the independent Medicare advisory board would not find a 
benefit that they would suggest cutting?
  Mr. DODD. Absolutely. That is not allowed under this. You cannot cut 
guaranteed benefits. Going back and looking at providers--
  Mr. BURR. If the Senator will yield for an additional question: Is 
this board empowered to find $23.4 billion worth of cuts?
  Mr. DODD. Not under guaranteed benefits. That is very clear.
  Mr. BURR. Will the Senator show me that language?
  Mr. DODD. The board is prohibited, forbidden, from proposing changes 
that would take benefits away from seniors or increase their costs. The 
board cannot ration care, raise taxes on Part B premiums, or change 
Medicare benefits eligibility or cost-sharing standards.
  It couldn't be more clear. They are absolutely prohibited from doing 
that. And that is the point we have been trying to make here. Frankly, 
as we know, there are hospitals that will tell you themselves, in many 
cases, as a provider, there are cost savings there. I am told--and 
again my colleagues know more about these details than I do--that it is 
not uncommon for an elderly person to leave a hospital and, on average, 
be given four prescription drugs to take. I am told as well that within 
a month or so that elderly person is not following their prescriptions 
very well--either they live alone, or for one reason or another they do 
not follow their prescriptions--and they end up being readmitted. There 
is a very high readmission rate in hospitals, thus raising the cost for 
hospitalization.
  Our bill makes significant efforts to try to reduce the problem of 
hospital readmissions, which, again, raises costs tremendously. That is 
where the savings are coming from here, by taking steps to try and 
reduce the readmission rate to the hospitals. That is a cost savings 
that is not denying a benefit to the elderly. It is trying to save 
money and save lives. That is what we are trying to achieve here.
  But, again, I challenge any Member to come up and identify a single 
guaranteed benefit under Medicare that is cut in this bill. There are 
none. And 78 percent of our elderly should not be required to pay 
additional premiums to take care of a handful of other people out 
there. I understand why they want some of these benefits, and they 
shouldn't be denied them, if they want to pay for them, but don't 
charge the other Medicare beneficiaries for the benefit they never get.
  Mr. DURBIN. Will the Senator yield for a question?

[[Page 29062]]


  Mr. DODD. I would be happy to yield to my colleague.
  Mr. DURBIN. It is interesting to me that under the McCain amendment, 
the first line in the amendment--the motion to commit--relates to 
Medicare Advantage. I used to work for an old fellow in Illinois 
politics named Cecil Partee, and Cecil said: For every issue in 
politics, there is a good reason and a real reason. We hear a lot of 
good reasons on the floor for this McCain amendment and the future of 
Medicare. The real reason is on the first line of Senator McCain's 
motion to commit. He says: Send this back to committee and don't touch 
Medicare Advantage.
  I want to ask the Senator from Connecticut about Medicare Advantage, 
because some of the things I have read around the country about 
Medicare Advantage tell me this plan, run by private health insurance 
companies, costs more than basic Medicare. These companies promised us, 
when they got involved, they would show us how to run a health 
insurance plan. They would show us how to provide Medicare benefits and 
they would save us money. Some have. But by and large, if I am not 
mistaken, isn't the verdict in--a 14-percent increase in cost for 
Medicare benefits under this Medicare Advantage?
  Mr. DODD. My colleague from Illinois is absolutely correct, it is 14 
percent. In some States it is 50 percent more.
  Mr. DURBIN. When we talk about saving over $100 billion in the 
Medicare Program over the 10 years, part of it is by saying to those 
private health insurance companies that are overcharging Medicare 
recipients, the party is over. The subsidy is over. We are going to 
make sure that every American who qualifies for Medicare gets the basic 
benefits, but we will not allow these private health insurance 
companies to get a subsidy from the Federal Government at the expense 
of Medicare and its recipients.
  Mr. DODD. And then charging the other 78 percent of Medicare 
recipients to raise their premiums. That is the outrage of all this.
  Mr. DURBIN. So the motive behind the McCain amendment is less about 
saving Medicare and more about saving a private health insurance 
program called Medicare Advantage.
  Mr. DODD. And talk about misbranding, calling something Medicare 
Advantage. It is neither Medicare nor an advantage. Quite the opposite, 
in fact.
  You are accurate in your numbers, by the way, because I want people 
to know, as much as we respect the Senator from Illinois and his math, 
the numbers he identifies of $100 billion this program is costing us, 
comes from the Congressional Budget Office. We didn't make up these 
numbers. That is the cost savings by modifying Medicare Advantage that 
has cost us so much and deprived the overwhelming majority of our 
elderly the benefits they end up paying for. So I appreciate very much 
the Senator's question.
  Mr. BAUCUS. If the Senator will yield for another question, might I 
ask my friend if it isn't also true that in the June MedPAC report it 
states that Medicare Advantage overpayments cost taxpayers an extra $12 
billion?
  Mr. DODD. That is correct. And again, that is MedPAC.
  Mr. BAUCUS. Well, that is right, that is MedPAC. I think the point 
the Senator from Illinois is making needs to be underlined two or three 
or four times here--and the Senator from Connecticut has made it too--
and that is there is a huge distinction between Medicare and these 
private insurance plans.
  Mr. DODD. I think too many of our fellow citizens hear the word 
Medicare Advantage and assume that is the Medicare Program, and it is 
not.
  Mr. BAUCUS. It is not. It is a private plan.
  What Medicare Advantage is overpaid--that is what these insurance 
companies are overpaid, and a lot of that goes back to the Part D drug 
bill and so forth--do those overpayments necessarily mean better 
benefits for persons who signed up for those plans?
  Mr. DODD. No. In fact, there is no evidence that overpayments to 
plans leads to better health care. That is again according to MedPAC.
  Mr. BAUCUS. If that is true, why might that be the case, just so 
people understand?
  Mr. DODD. Because insurers, not seniors or the Medicare Program, 
determine how these overpayments are used. And too often they are used 
to line the pockets of insurers, to increase their profits and not to 
provide benefits.
  Mr. BAUCUS. Does Medicare decide what the benefits will be for those 
folks?
  Mr. DODD. No, it is the private carriers that decide that.
  Mr. BAUCUS. The private insurance carriers.
  Mr. DODD. Yes, they are the ones that set the rates and determine 
where the profits go. That is why it is such a misnomer to call this 
Medicare Advantage, because it is neither Medicare nor an advantage.
  The PRESIDING OFFICER. The time has expired.
  Mr. DODD. Mr. President, I ask unanimous consent for 2 additional 
minutes.
  The PRESIDING OFFICER. Is there objection?
  Mr. COBURN. Reserving the right to object, I will ask for 2 
additional minutes for my side.
  Mr. DODD. Well, I gave 2 minutes to my friends earlier.
  Mr. COBURN. How about 1?
  Mr. DODD. OK, 1. Well, make that 2. If he wants 2 additional minutes, 
I have no problem giving my colleague 2 additional minutes.
  Mr. BAUCUS. You already said it, but I think it is worth repeating--
--
  The PRESIDING OFFICER. Without objection, the request is agreed to.
  Mr. BAUCUS. Most seniors, as they pay Part B premiums under fee for 
service, don't get any benefit whatsoever?
  Mr. DODD. That is correct. None whatsoever. In fact, all they do get 
is higher premiums.
  Mr. BAUCUS. That is right. Higher premiums.
  Mr. DODD. Higher premiums. And 78 percent, almost 80 percent are 
paying more for a program from which they never get any benefit.
  Mr. BAUCUS. The figure I saw--I guess it is $90 a year they pay extra 
and get no benefit from it.
  Mr. DODD. So vote for the McCain amendment and you do exactly what 
Senator Durbin is suggesting: Preserve Medicare Advantage, and under 
Medicare Advantage 78 percent of our elderly pay more premiums, never 
get any benefits, and the private carriers get to pocket the 
difference. That is a great vote around here. That is great health care 
reform.
  Mr. DURBIN. I say to the Senator from Connecticut, could we 
characterize this as an earmark in the Medicare Advantage Program?
  Mr. DODD. It is two ears, not even one ear. I give it two ears.
  Mr. BROWN. I say to Senator Dodd, we remember 10 years ago when the 
insurance companies came to the government and said we can do something 
that later became Medicare Advantage, and we can do it less 
expensively. They said we can do it for 5 percent less than the cost of 
Medicare and the government unfortunately made the agreement with them 
to sign up to do that. Then what happened in the last 10 years is, the 
insurance lobbyists came here and lobbied the Bush administration and 
lobbied the Congress and got bigger payments. It is a subsidy for the 
insurance companies, but you and Senator Baucus and Senator Durbin said 
it is not Medicare, it is private insurance, privatized form of 
Medicare that serves the insurance companies very well, is that 
correct, but doesn't serve the seniors in this country?
  Mr. DODD. I will sit here all day waiting for someone to identify a 
single benefit guaranteed under the Medicare Program that is cut in our 
bill. They are all talking about Medicare Advantage, not Medicare. 
There are no guaranteed benefits cut under this bill nor can those 
benefits be cut. Our legislation bans and prohibits any cuts in 
guaranteed benefits.
  The PRESIDING OFFICER (Mr. Casey). The Senator from Oklahoma is 
recognized.
  Mr. COBURN. One of the questions and one of the promises was: If you

[[Page 29063]]

have what you have now and you like it, you can keep it. What is 
happening under this bill for 11 million seniors on Medicare Advantage, 
that is not going to happen. If they like it, they are not going to be 
able to keep what they have. You can't deny that. That is the truth.
  Medicare Advantage needs to be reformed. There is no question about 
it. I agree. As the Senator alluded to, in the Patients Choice Act we 
actually save $160 billion in the Patients' Choice Act, but we don't 
diminish any of the benefits, and we do that because CMS failed to 
competitively bid it, because when it was written--and I understand who 
wrote it--when it was written we didn't make them competitively bid it. 
You could get the same savings, actually get more savings and not 
reduce benefits in any amount, if you competitively bid that product. 
But we have decided we are not going to do that.
  The second point I make with my colleagues is the vast majority of 
people on Medicare Advantage are on the lower bottom economically. They 
can't afford an AARP supplemental bill. They can't afford to pay an 
extra $150 or $200 a month. So what happens most of the time with 
Medicare Advantage is we bring people up to what everybody else in 
Medicare gets because most people can afford--84 percent of the people 
in this country can afford to buy a Medicare supplemental policy 
because Medicare doesn't cover everything.
  Your idea to try to save money, I agree with. But cutting the 
benefits I do not agree with. You are right, Senator Dodd, the basic 
guaranteed benefits have to be supplied to Medicare Advantage and then 
the things above that which you get from the supplemental policy, what 
you can afford to buy, is what these people get. And what you are 
taking away from poorest of our elderly is the ability to have the same 
care that people get who can afford to buy a supplemental policy. That 
is the difference.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. COBURN. I appreciate my chairman for his courtesy in yielding the 
time.

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